Hospital Nurses ? - What is your patient/nurse ratio?

[MickeyMouth]

Wow! After reading some of these replys, I realize how good I have it at my Hospital. I work on a 45 bed Medical/Oncology floor with 16 tele monitored beds. We usually have enough RNs to keep the ratio at 1 to 5. We also have 2 charge nurses every day during the week (1 on the weekends) who do all of the discharges and help us out by starting IVs, giving meds, etc. The hospital also has an admissions team who handle all of the admission paperwork. We have 3 techs (CNAS), each assigned to one of the mods. We have transporters to take pts. to and from tests. Currently we are being offered a $150 bonus plus time and a half for each extra day we choose to pick up. We are a Magnet hospital and have a professional ladder. However, even with all of this, there are still crazy, hectic, stressful days. This is a great thread! I would love a nurse venting board!

 

[roseprincess]

I think there are several reasons for the shortage, none of which are going to disappear in the next few years!!!

1. Women have more and different careers availablke to them than they did 25 years ago. Realizstically, there was a time when teacher, nurse, secretary were your 3 choices if you were a woman. These days, women can really be anything.

2. Though it is slowly changing (thank God!!!!), there is still somewhat of a "stigma" to being a man and a nurse.

3. The pay, while it is decent, is not all that great when you think of the amount of responsibility you have and the working conditions (shifts, holidays, weekends, short-staffing, lawsuits which are threatened at every turn...to name a few).

4. There is an overall lack of respect for nurses. Many people still see us as the doctors handmaidens.

5. Administrators in general have very little respect for staff nurses, despite what they always say.

6. I don't think young people today are as willing to do "dirty" work. Let's face it...there are some aspects of nursing that are dirty and kind of disgusting in and of themselves. I am not the type of person that stuff like that bothers, but it is dirty work sometimes. Even my mother, who is very proud that I am a nurse, will sometimes say "I wish you had gotten a nice clean job" if I am telling her a story about work where there are some gory details.

I agree with all the reasons . Reasons #4 and #5 I have seen alot when I worked as a staff RN. The respect was so poor to the staff nurses.

 

[Poohlovr]

How how does a hospital "mandate" that you stay ? Do they threaten to report you to the BON if you leave ? How does this work if managament is at home? When I am on call (as someone always should be) you'd better believe my charge nurse calls me in if they are short!

I don't know about anywhere else, but, it's included in our job description and if we are mandated, and refuse to stay, we can be fired. Period.

And, yes, we have been getting mandated (only for 4 hrs, though) lately. We are only mandated if the next shift is short at least 2 nurses. Short one and the shift just works short.

We don't have on-call staff for the floor. Only the specailty areas, (cath lab, surgery, endo, etc) have on-call staff.

 

[WebmasterAlex]

I think Viking's wife is the winner, I have never heard of anything like that... it's impossible!

 

[MEG&MINNIE]

My friends who work as nurses up here in Mass. do not have manditory overtime and also,do not have to "float"to another unit .They have strong unions to represent them! It's about time!!! One of my worst days working as an R.N.,was when I ,an OB/GYN nurse got floated one evening to a Medical Floor,was given a brief report on my 7 or so patients and then half way thru my shift one of my assigned patient died on me !!! I never had a patient die before on me (remember I came from an OB/Gyn Floor). This is so unfair to our nurses and to the patients themselves. I was not comfortable floating or qualified really in some of these areas.Our licenses are at stake when we are working short staffed or forced to float. Like I stated in an earlier post ,I have not worked for nearly 20 years now,but I do maintain my license.

 

[firstmickey]

I am a nurse in a union and it states in my union contract that mandation will occur only in case of emergency. Well, every darn day is an emergency! And if they mandate you to stay...you stay....or it's patient abandonment. And you are fired AND could lose your nursing license.

Supposedly all other avenues of staffing such as charge nurses assigned, management called (yeah right ) and beds closed (NEVER HAPPENS) before mandation occurs. I was threatened with mandation twice this week but luckily both times, someone came in. I know three nurses that were mandated to stay 11-7am after a 3pm-11pm shift, etc. They dont care if you have kids and no babysitter, etc. They tell you they have no choice...no one to take your assignment...and you stay.

it's to the point where I won't pick up extra time unless I know I can stay that evening/night because you never know if they will let you go home!

I work in the Per Diem Float pool and it is always the float pool staff that gets mandated! Im really tired of it!


Plus Im tired of giving terrible patient care because I dont have time to do all the extra comfort care things that I like to do for my patients and their families.


Disney Doll.....I agree with both of your posts and think they were very well said!

 

[mermaidlady]

I hear you all. I work in an ICU and usually have1:2 staffing. Was on the weekend and because it was a holiday and a weekend we were short. Had 1 pt that could have been moved to the floor but no beds. Then when they wanted to admit 2 pts and we said no because of staffing a bed was found at 1AM. That part really annoys me. Why do we have to wake up a pt in the middle of the night to transfer? The hospital likes to hold beds when the ER is filled.

 

[roliepolieoliefan]

I'm an RN but no longer work in a hospital. I work in a surgery center. After reading these posts, I have to say I feel for all of you. I know I make at least $10.00 an hour if not more less than you guys, but sometimes its just not worth it.

Hang in there!

 

[WebmasterAlex]

I was a little curious about this so I did a little bit of looking around on the internet. In many states a nurse can't lose their license for refusing to work past their scheduled hours. It seems like management uses that as a threat but it just isnt' true in a lot of places. Here is an example from Massachusetts, it specifically states that a nurse can't be charged with abandoment:



BORN policy statement on patient abandonment</FONT> </FONT>

Standard of Conduct Policy 01-01

Title: Determination of Compliance with the Standard of Conduct at 244 CMR 9.03(15) Prohibiting Patient Abandonment

Purpose: The Board of Registration in Nursing adopts this policy to establish criteria for the evaluation of compliance with its regulation at 244 CMR 9.03(15) prohibiting patient abandonment by a licensed nurse.

Dates Adopted/ Revised: July 12, 2000; September 13, 2000 (revised)

Policy: When the Board evaluates a complaint of patient abandonment, it will determine whether patient abandonment has occurred based on information demonstrating that the licensed nurse:

a) accepted responsibility for the nursing care of a patient or group of patients;

b) voluntarily withdrew from caring for the patient or patients with any ongoing nursing care need;

c) failed to give reasonable notice to an appropriate person that she or he was withdrawing from caring for the patient or patients so that arrangements could be made for continuation of safe care; and

d) failed to report essential information to an appropriate person.

The Board evaluates each allegation of patient abandonment on a case by case basis. In general, the Board would not consider that patient abandonment has occurred when a nurse is asked to work beyond the nurse’s established work schedule and informs the employer that she or he is unable to do so.

The following situation is an example of patient abandonment:

• A nurse accepts an assignment of patient care and then leaves the facility. The appropriate licensed nursing staff does not know that the nurse is not in the facility, nor has the nurse given a status report on her patient or patients to another nurse who assumes responsibility for patient care.

The following situation is not an example of patient abandonment: • A nurse ends her or his employment relationship without advanced notice, provided that the nurse has not accepted responsibility for the nursing care of a patient or group of patients.

 

[WebmasterAlex]

And here is Pennsylvania, please note this is a bit old and I can't guarentee there have been no changes since :

In 1993, the Pennsylvania State Board of Nursing was asked to further clarify the term abandonment. The following statement is taken from the Pennsylvania Bulletin, Vol. 23, No. 18, May 1993:

"The Board's intent in drafting this provision is to prohibit a nurse from leaving a patient in need of nursing care when there is a violation of duty to provide for that care. The Board intends that this provision applies only during a nurse's normal working hours and would not prohibit a nurse from refusing to stay for a second shift when there is a shortage of staff."
​

 

[WebmasterAlex]

A rather long opinion from Michigan:

http://www.ag.state.mi.us/opinion/datafiles/2000s/op10159.htm

 

[Viking]

In thew UK we have a lot of foreign nurses, some being from the Phillipines. We do have some communication problems, especially when they communicate with the patients. In addition I have worked with foreign nurses that don't follow basic procedures for infection control and aseptic technique etc. I don't know whether this is a result in the difference in training or whether it's just down to the individual not caring enough to follow evidence based practice.

We also 'imported' lots of nurses from Vietnam and the Phillipines in the 70ies and from Former Yugoslavia in the late 80ies/early 90ies, but all had to do mandatory one year training to bring their education to German standards and to learn the language. The majority of them adapted very good to their new home country.

 

[Viking]

I am a nurse in a union and it states in my union contract that mandation will occur only in case of emergency. Well, every darn day is an emergency! And if they mandate you to stay...you stay....or it's patient abandonment. And you are fired AND could lose your nursing license.

Supposedly all other avenues of staffing such as charge nurses assigned, management called (yeah right ) and beds closed (NEVER HAPPENS) before mandation occurs. I was threatened with mandation twice this week but luckily both times, someone came in. I know three nurses that were mandated to stay 11-7am after a 3pm-11pm shift, etc. They dont care if you have kids and no babysitter, etc. They tell you they have no choice...no one to take your assignment...and you stay.

it's to the point where I won't pick up extra time unless I know I can stay that evening/night because you never know if they will let you go home!

I work in the Per Diem Float pool and it is always the float pool staff that gets mandated! Im really tired of it!


Plus Im tired of giving terrible patient care because I dont have time to do all the extra comfort care things that I like to do for my patients and their families.


Disney Doll.....I agree with both of your posts and think they were very well said!

Over here we have laws stating that you're not allowed to work more than 10 hours a day (plus breaks), not more than 60 hours a week, and not more than an average of 48 hours per week over 26 weeks. Only in an absolute emergency you are allowed to break the 10 hour rule and the management has to submit a written statement to the works council to justify this.
To be honest: I wouldn't want to be cared for by someone having worked like 16 hours in a row.

 

[catherine]

We also 'imported' lots of nurses from Vietnam and the Phillipines in the 70ies and from Former Yugoslavia in the late 80ies/early 90ies, but all had to do mandatory one year training to bring their education to German standards and to learn the language. The majority of them adapted very good to their new home country.

The nurses that come here from other countries do adaptation traning, the problem is that some of the nurses are trained better than others. Some foreign nurses get excellent training and some are looked on as just another pair of hands, especially inplaces like elderly nursing homes! The bottom line is that a lot of foreign nurses come over here and are basically left to get on with it, because UK nurses don't have time to babysit them!

 

[firstmickey]

And here is Pennsylvania, please note this is a bit old and I can't guarentee there have been no changes since :

In 1993, the Pennsylvania State Board of Nursing was asked to further clarify the term abandonment. The following statement is taken from the Pennsylvania Bulletin, Vol. 23, No. 18, May 1993:

"The Board's intent in drafting this provision is to prohibit a nurse from leaving a patient in need of nursing care when there is a violation of duty to provide for that care. The Board intends that this provision applies only during a nurse's normal working hours and would not prohibit a nurse from refusing to stay for a second shift when there is a shortage of staff."
​

Over here we have laws stating that you're not allowed to work more than 10 hours a day (plus breaks), not more than 60 hours a week, and not more than an average of 48 hours per week over 26 weeks. Only in an absolute emergency you are allowed to break the 10 hour rule and the management has to submit a written statement to the works council to justify this.
To be honest: I wouldn't want to be cared for by someone having worked like 16 hours in a row.

As for the first thing about PA law, that might be well and good....but the grief and aggravation you would have to go thru at my hospital if you leave when you were mandated to stay would be extreme. there have been nurses mandated who have filed grievances that took YEARS. They did result in back pay, etc....these nurses were on call and mandated to stay and the hospital didnt continue to pay them on call time and half....they went back to paying them straight time! (they won).
I know they use scare tactics, etc to get you to stay...but honestly, no one really feels right just leaving when they know there isn't anyone to really replace you. One thing I know...our union contract is up in November....and let me tell you....this is the NUMBER ONE thing people want to change...even more than money.

As for hours worked, we can be mandated to stay 20 hours total worked time, but I have never heard of anyone being mandated to stay more than a 16 hour shift total. I know you need 9 hours off if you work 7am-11pm and are due to come back daylight...they usually have you come back at 11am.
(nice of them, huh? )

 

[WebmasterAlex]

I totally understand about the grief and agravation and they could fire you. Knowing that your license is safe though takes away a little bit of the "power". Besides it's good to know management is making empty threats.

 

[Disney Doll]

I have actually kept the policy on "mandation" in my locker, and the few times when there has been talk of mandation and patient abandonment, where it was being bandied about in relation to me being the person doing it, I made sure the part of management's responsibility in providing for appropriate staffing, and not nursing being able to be accused of abandonment, was highlighted.

 

[Poohlovr]

To their credit, our administration never uses "abandonment" in regards to mandating us--they only use the word "fired".

 

[Disney Doll]

To their credit, our administration never uses "abandonment" in regards to mandating us--they only use the word "fired".

And I'd be using the word lawsuit.

 

[Disney Doll]

To their credit, our administration never uses "abandonment" in regards to mandating us--they only use the word "fired".

And I'd be using the word lawsuit.